Drugs to kick smoking now free by mail except for
elderly

March 28, 2013

By Tom Philpott

Smoking cessation drugs now are
available at no charge through the TRICARE Mail Order Program for
service members, military family members and retirees under age 65 who
want to kick this unhealthy habit.

The free cessation drugs finally are
available almost five years after Congress ordered them. The free
medicines are part of a wider smoking cessation program that lawmakers
told the Department of Defense to establish under provisions of the
fiscal 2009 defense authorization act.

The same law also directed TRICARE to
boost long-standing smoking cessation efforts with in-person counseling,
access to print and web-based material on health effects of tobacco, and
a 24-hour, toll-free"quit line"with counselors to
assess readiness of smokers to quit and recommend ways to address their
nicotine dependency.

The smoking cessation program,
including mail-order drugs, patches, gums, lozenges and sprays, is not
available to beneficiaries eligible for Medicare, which means the
TRICARE for Life population. This is set in law to hold down
costs. It also is not available outside the United States except to
active duty members and families enrolled in TRICARE Prime
overseas.

The toll-free quit line likely will not
be available overseas because of"technological
barriers and costs involved in providing this service,"TRICARE
officials explained in a final rule published in the Federal Register
Feb. 27.

Free mail-order drugs include heavily
promoted medicines such as varenicline (brand name Chantix) and
buproprion (Zyban), and popular nicotine replacement including patches
and inhalers. All of them will require a prescription and"we
can’t guarantee that every med will be available to every
individual,"said a TRICARE official."That’s
still a doctor’s call based on the person’s health and
other medications."

Many of these drugs also are being
stocked at base pharmacies to be available at no charge. How base
pharmacies handle TRICARE for Life patients with prescriptions for these
drugs is to be a local issue, officials explained. Even though
Medicare-eligible beneficiaries are excluded from the smoking cessation
program, drug access policies vary by base. Therefore, elderly smokers
should check with their base pharmacy to learn if they can access
cost-free smoking cessation drugs too, said officials.

The estimated cost of dispensing free
smoking-cessation drugs by mail is $24 million a year. Congress approved
this to try to drive down smoking-related diseases and long-term health
costs. It was estimated in 2007 that tobacco-related diseases cost the
military at least $500 million a year.

Health effects of smoking, including
cancers, respiratory diseases and heart ailments, kill 443,000 Americans
annually, the Centers for Disease Control and Prevention report. Smoking
causes 90 percent of lung cancer deaths in men and 80 percent in women,
the CDC experts estimate.

The military has a higher incidence of
tobacco use than the U.S. adult population overall. The most recent DoD
Health-Related Behaviors Survey, from 2011, found 24.5 percent of the
military use cigarettes"in the past 30
days"versus 20.6 percent of civilians. Marines had the highest
smoking rate of the armed services at 31.9 percent. Air Force is lowest
at 17.2 percent.

Smokeless tobacco usage is 12.8 percent
in the military versus only 2.3 percent among civilians. Again, Marines
report the highest smokeless usage rate at 21.3 percent, and Air Force
the lowest rate with 8.7 percent.

Among heavy cigarette smokers, 45
percent endorse prescription medication as the preferred form of
treatment for their nicotine dependence.

TRICARE officials published a proposed
rule on free home delivery of smoking cessation medicines in September
2011. Most public comments were positive. A few questioned why the meds
would not be available in the TRICARE retail pharmacy network. Officials
said mail order is more cost-effective and won’t be a
barrier to seeking care for most beneficiaries.

The National Community Pharmacists
Association commented that some retail pharmacists could provide
face-to-face cessation counseling. But TRICARE officials said retail
pharmacists"are not recognized as authorized TRICARE independent
providers"so counseling would not be a covered benefit and
pharmacists could not be paid for such services.

Also, officials explained, the mail
order program provides around-the-clock access to pharmacists via a toll
free phone number, and with every drug comes"complete written
instructions for use, side effects, adverse effects, warning and
telephone numbers for questions."

Smokers will be allowed two"quit
attempts"a year and still stay eligible for counseling sessions
and medicines. Even a third quit attempt may be covered"with
physician justification and pre-authorization."One respondent to
the proposed rule said this was too lax and would waste TRICARE
resources in allowing more years of coverage and more quit
tries.

But TRICARE officials said extensive
research revealed that, on average, smokers need seven attempts to
finally quit. And when they do, future TRICARE costs are
reduced.

Stateside commissaries now plan to
close Mondays, rather than Wednesdays, from May through September if
civilian employees are furloughed due to automatic budget cuts of
sequestration.

The switch in plans results from a
negotiation this month between the Defense Commissary Agency and the
American Federation of Government Employees, which represents many
commissary employees.

Defense officials last Friday told
agencies and departments to delay furlough notices to allow time to
assess how the 2013 defense appropriation bill passed by Congress last
week impacts total operating dollars.